Treatment of Graves’ disease in Iran
Graves’ disease is an immune system disorder that leads to overproduction of thyroid hormones (hyperthyroidism).
Although a number of disorders may lead to hyperthyroidism, Graves’ disease is a common cause.
Thyroid hormones affect many body systems, so the signs and symptoms of Graves’ disease can range widely.
Although Graves’ disease can affect anyone, it is more common in women and in people younger than 40.
The main goal of treatment is to reduce the amount of thyroid hormones that the body produces and reduce the severity of symptoms.
Thyroid hormones regulate body temperature, heart rate and metabolism. Hyperthyroidism causes problems in organs such as the heart as well as bones and muscles.
What is Graves’ disease?
Graves’ disease is an autoimmune disease that damages the thyroid gland.
This butterfly-shaped gland in the neck produces hormones that regulate how the body uses energy (metabolism).
Graves’ disease is the most common cause of hyperthyroidism. People with Graves’ disease produce too much thyroid hormone, which can damage the heart and other organs.
The disease takes its name from Robert Graves, an Irish physician who first described the disease in the 1800s.
Symptoms of Graves’ disease
Hyperthyroidism
Graves’ disease is the most common cause of hyperthyroidism, therefore, hyperthyroidism is considered as the first symptom in the disease, although hyperthyroidism manifests itself with many symptoms:
- Common symptoms of hyperthyroidism
- Anger and irritable mood
- Trembling in fingers or hands
- Being sensitive to heat
- More sweating and moist skin
- Weight loss despite not losing appetite and usual food or even with more appetite
- Goiter and enlargement of the thyroid gland
- Changes in the menstrual period in women
- Difficulty in pregnancy
- Frequent bowel movements and diarrhea
- Fast and irregular heartbeat
Eye diseases and problems in Graves’ disease (ophthalmopathy)
Approximately 30% of people who suffer from Graves’ disease face symptoms such as redness and swelling of the eyes.
In this case, inflammation and other effects of the body’s immune system are created on the muscles and tissues around the eyes and cause redness and burning problems in the eyes. The symptoms of this type of ocular thyroid are:
- extraocular
- Pain or pressure in the eye
- Red and swollen eyes
- sensitivity to light
- double vision
- Loss of vision
- Elevation of the upper eyelid, which is also the reason for eye protrusion.
- Pulling back of the eyelids
Skin symptoms (thyroid dermopathy)
Other effects of Graves’ disease are skin problems. Graves’ disease can cause reddening and thickening of your skin in the leg area or the upper part of the foot. This condition is usually painless, but in some people it can be accompanied by pain.
Why does Graves’ disease occur?
Graves’ disease occurs when, for unknown reasons, the body’s immune system sees the thyroid gland as an invader and fights against it.
As mentioned, the body’s immune system naturally produces antibodies that are actually used to destroy viruses and bacteria.
The pituitary gland produces a hormone called TSH, which normally controls the production of thyroid hormone, in Graves’ disease, the TRAb antibody acts like the TSH regulatory hormone, thus increasing thyroid function and producing more thyroid hormone and hyperthyroidism. will be
Graves’ disease manifests itself as hyperplasia of thyroid cells, which means that the cells that produce thyroid hormones increase, and this, as well as the increase in thyroid function, gradually manifests itself in the enlargement of the gland and goiter.
What are the underlying factors or risk factors of Graves’ disease?
Regarding Graves’ disease, it should be said that every person has the possibility and probability of contracting it, but there are some factors that can be considered as risk factors and factors that favor the development of this disease and increase its risk. These factors are: :
family history
This disease manifests itself more in those who have had a family history of it, for this reason, the gene or genes may have been involved in creating the background for it and make the person more at risk.
gender
Graves’ disease is more common in women than in men.
Age
People under the age of 40 are at a higher risk of developing Graves’ disease.
Presence of other autoimmune diseases such as arthritis and type 1 diabetes
Statistics show that people with a history of autoimmune diseases such as type 1 diabetes or arthritis are more likely to have this thyroid disease.
Emotional or physical stress
In people who have sensitive genetic backgrounds regarding this disease, the existence of an emotional stress or a physical injury can be an excuse for the onset of this disease.
pregnancy
In women prone to Graves’, pregnancy can be the foundation for this disease.
smoking
Smoking can suppress the immune system and weaken it, which is a danger sign for people prone to Graves’ disease.
More complications of Graves’ disease
Dangerous pregnancy
During pregnancy, this disease can cause miscarriage, premature birth, disruption of fetal thyroid function, heart failure in the mother, or preeclampsia (high blood pressure during pregnancy), which are dangerous and serious factors.
heart problems
Failure to treat Graves causes the patient’s heart to have disturbances in the rhythm and speed and intensity of the beat and not have enough ability to pump enough blood.
Thyroid storm
A rare and dangerous disease that can lead to the sudden death of the patient, during which the patient experiences symptoms such as nausea, vomiting, lethargy, convulsions, and rapid heartbeat.
Weak and brittle bones
Osteoporosis and its fragility can also be one of the complications related to such diseases in the thyroid (diseases that cause hyperthyroidism).
Diagnosis of Graves’ disease in Iran
When you visit a doctor for a diagnosis, first clinical examinations are performed and the possibility of hyperthyroidism is checked despite its symptoms.
If there are symptoms of hyperthyroidism, the final diagnosis of hyperthyroidism is given by thyroid test and measuring the level of T3, T4 and TSH hormones.
The amount of these hormones increases in Graves’ disease. To diagnose Graves’ disease, the doctor examines its secondary symptoms, including rheumatoid arthritis, dangerous anemia, skin problems such as vitiligo, or eye problems such as eye protrusion.
Usually, the definitive diagnosis of Graves’ disease is finalized by performing the TRAb test, which is performed through a blood test. The presence of this antibody in the body indicates Graves’ disease.
But if the doctor detects symptoms of Graves’ disease and the blood test does not confirm it, a radioactive iodine uptake test (RAIU) is performed, and ultrasound can also help in diagnosing this disease.
Treatment of Graves’ disease in Iran
drugs such as propranolol are primarily used in the treatment of this disease to reduce the symptoms of hyperthyroidism.
This drug can control the heart rate and compensate for the increase in heart rate caused by hyperthyroidism.
Its daily dosage depends on the patient’s condition and is up to 40 mg daily, which of course must be prescribed by a doctor
Also, this type of drug is not used for asthma sufferers, although these drugs do not cure hyperthyroidism, but are effective in controlling hyperthyroidism.
This drug can control the heart rate and compensate for the increase in heart rate caused by hyperthyroidism.
Its daily dosage depends on the patient’s condition and is up to 40 mg daily, which of course must be prescribed by a doctor
Also, this type of drug is not used for asthma sufferers, although these drugs do not cure hyperthyroidism, but are effective in controlling hyperthyroidism.
Antithyroid drugs
The next treatment options used are anti-thyroid drugs, such as propylthiouracil and methimazole, each of which is used depending on the patient’s condition.
Propylthiouracil drug can be used during pregnancy due to less side effects on the fetus.
Treatments such as surgery and radioactive iodine are also used to treat Graves’ disease, although this is different for pregnant women.
In Graves’ treatment, if methimazole is chosen and after 12 to 18 months the tests show a decrease in TSH and TRAb, the treatment can be stopped. If the antibody level remains high, the chance of treatment decreases and antithyroid drugs must be continued.
Surgery and radioactive iodine
Radioactive iodine treatments and surgery are also used for treatment, but there is evidence that radioactive iodine treatment may increase Graves’ eye symptoms.
For this reason, this method is not used in patients with severe eye symptoms.
There is a possibility of hypothyroidism after surgical procedures and radioactive iodine, and in some cases the doctor has to choose these methods.
For this reason, this method is not used in patients with severe eye symptoms.
There is a possibility of hypothyroidism after surgical procedures and radioactive iodine, and in some cases the doctor has to choose these methods.
RF and microwave
Finally, if Graves’ disease or hyperthyroidism have followed the development of toxic or hyperactive nodules
Less invasive RF and microwave methods are very helpful
In these methods, with the help of a thin needle and in a state where the patient is conscious but has received local anesthesia, microwave and RF waves are irradiated to the active nodule and the nodule is removed without damaging the thyroid parenchyma tissue.
This method has been performed for several years in Iran by highly specialized doctors and has produced excellent results
Less invasive RF and microwave methods are very helpful
In these methods, with the help of a thin needle and in a state where the patient is conscious but has received local anesthesia, microwave and RF waves are irradiated to the active nodule and the nodule is removed without damaging the thyroid parenchyma tissue.
This method has been performed for several years in Iran by highly specialized doctors and has produced excellent results
Does Griever’s disease have a definitive cure?
In the treatment of Graves’ disease, the first goal is to lower the thyroid hormone level to eliminate the symptoms of hyperthyroidism.
This treatment includes a method to prevent the production of thyroid hormone by the gland.
Treatment methods such as radioactive iodine, surgery, and also in case of hyperfunction with the presence of a thyroid mass, Araf and microwave treatments can be performed.
After the treatment of the disease, to eliminate the effects of the disease, plastic surgery or cosmetic eye surgery may be needed
For this purpose, consult Dr. Mehran Zarei – surgeon and eye specialist
